微创Nuss手术矫治不同年龄段先天性漏斗胸的临床效果

Clinical efficacy of minimally invasive Nuss surgery in the treatment of patients with pectus excavatum at different ages

摘要:

目的：总结微创Nuss手术矫治不同年龄段先天性漏斗胸的矫形效果，为临床手术时机的选择提供依据。方法：选择3～、6～、≥12岁漏斗胸患儿各20例，均行微创Nuss手术矫治，从围术期情况、术后并发症、术后矫形效果等方面进行比较。结果：不同年龄段漏斗胸患儿的手术时间、出血量、术后住院时间差别不大，差异无统计学意义；而术后使用镇痛药时间、下地活动时间随着年龄的增大而延长，差异有统计学意义；３组均无严重致命性并发症发生，术后并发症的发生率不同年龄段之间无明显差异，且预后良好。术后矫形效果除≥12岁病例组有１例中等外，其余均为优良，且年龄越大术后矫形效果优的比例越少；随着年龄的增大，出现心理障碍的比例明显增加。结论：微创Nuss手术矫治不同年龄段漏斗胸均能取得较好的效果，但年龄越大矫形效果下降，心理障碍的发生率愈高，提示3～岁是微创Nuss手术最适宜的手术年龄。

Abstract:

Objective：To investigate the clinical efficacy of minimally invasive Nuss surgery in the treatment of patients with pectus excavatum at different ages. Methods：Twenty patients aged between 3-6（not including 6），20 patients aged between 6-12（nog in－cluding 12） and 20 patients aged older than 12 were selected and treated with Nuss procedure. Comparison was made between the three groups concerning the perioperative situation，postoperative complications and postoperative orthopedic effects. Results：There was no significant difference in operation time，amount of blood loss，postoperative hospital stay among groups of different ages. But the older the patients were，the longer time the analgesic and ambulation required，which were of significantly differences. There was no fatal postoperative complication in the three groups and there was no significant difference in complication incidence among groups of different ages. The orthopedic effects were fine except one case with age older than 12. With the growing of age，the psychological obstacles were increased，therefore，the orthopedic effects became less satisfactory. Conclusions：Nuss surgery can achieve fine ortho－pedic effects，which varies inversely with age. 3-6 years old is the ideal age for performing Nuss procedure surgery.